Drooping eyelid or ptosis is a condition that can be congenital or acquired. The main danger is that drooping eyelids can be not only an unpleasant cosmetic defect, but also be a symptom of a serious illness.
Normally, the edge of the upper eyelid overlaps the eyeball and iris by about 1/3. But this is not so important for determining the presence of ptosis, since drooping of the eyelid, as a rule, is immediately noticeable to both the patient and others, in comparison with a healthy eye.
A condition such as drooping of the upper eyelid can limit visibility due to a narrowing of the palpebral fissure, thus leading to excessive stress on the organs of vision, “overstraining” them. For this reason, prolapse is considered to be an ophthalmological pathology, which can cause visual impairment. However, a visit to a neurologist would not be a bad idea; more on that below.
Causes of drooping eyelids
The upper eyelid is more than just a flap of skin. The eyelid consists of a muscle that attaches to the cartilage in the eye socket. The muscle (it is called the muscle that lifts the upper eyelid) is located in the thickness of the subcutaneous fat.
The main causes of the pathology:
- a congenital disease that is associated with insufficient development of the muscle designed to lift the upper eyelid;
- injury to the muscle that lifts the upper eyelid;
- damage to the oculomotor nerve;
- stretching of the tendon of the muscle that lifts the upper eyelid (this condition is typical for old age);
- damage to the cervical sympathetic plexus (the so-called Horner's syndrome, expressed in ptosis, constriction of the pupil and “retraction” of the eyeball);
- diabetes mellitus as a cause of metabolic damage to muscles and nerves;
- acute cerebrovascular accident (in this case, drooping eyelid is accompanied by a number of other symptoms);
- tumor of the brain, spinal cord, or neck area;
- disturbance of neuromuscular transmission (myasthenia gravis or myasthenic syndrome);
- damage to the oculomotor nerve as part of polyneuropathy (in combination with damage to a number of other peripheral nerves);
- complication of botulinum toxin administration for cosmetic or medicinal purposes;
- botulism.
Considering the many factors that lead to drooping eyelids, consultation with a doctor is mandatory.
At CELT you can get advice from a neurologist.
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Horner's Syndrome - Causes
This pathological syndrome can develop as a result of various pathological processes, the development of which leads to damage to the sympathetic pathways at the level of the hypothalamus, brain stem, and cervical spinal cord:
- Inflammatory processes in the central nervous system
- Brain and spinal cord injuries
- Tumors of the brain and spinal cord
- Inflammatory diseases of the upper spine
- Inflammatory diseases of the first ribs
- Migraine
- Myasthenia gravis
- Multiple sclerosis
- Stroke (bleeding in the brain)
- Intoxication (primarily alcoholic)
- Trigeminal neuralgia
- Block of the cervical plexus, stellate ganglion
- Tumor located at the apex of the lungs (Pancoast tumor)
- Inflammation of the middle ear
- Aortic aneurysm
- Syringomyelia
- Neurofibromatosis type I
- Hyperpalasia (enlargement) of the thyroid gland due to goiter
- Cavernous sinus thrombosis
- Simatectomy (surgery to cut the sympathetic nerve in the neck)
Neurological diseases leading to ptosis
- Myasthenia gravis is a serious disease in which the transmission of impulses from nerve to muscle is disrupted. Myasthenia gravis is characterized by increased muscle fatigue. The disease affects all muscles, but the greatest manifestations can affect only the eye muscles, causing ptosis, double vision, and decreased focus. For the initial diagnosis of myasthenia gravis, a neurologist conducts a test with the introduction of proserin and examines the nerves and muscles using ENMG (electroneuromyography).
- Myopathy, in which double vision and drooping of both eyelids are also observed, while the performance of the muscle that lifts the eyelid is weakened, but present. Myopathies are of different types according to their origin. The examination uses needle EMG and a number of laboratory tests.
- Palpebromandibular synkinesis is involuntary concomitant movements that accompany chewing, abduction and opening of the lower jaw. For example, when you open your mouth, the prolapse can suddenly disappear, but after closing the mouth, it can be restored. This condition can be either an independent disease or the result of improper restoration of the motor fibers of the facial nerve after its damage.
- Bernard-Horner syndrome (expressed by a combination of drooping of the upper eyelid, narrowing of the pupil and “recession” of the eyeball). It is a manifestation of the pathology of the cervical sympathetic plexus. Sometimes the pathology is detected against the background of increased sweating on the face and incomplete paralysis of the brachial nerves on the affected side.
Horner's syndrome - Diagnosis in Israel
There are several diagnostic tests to identify Horner's syndrome:
- Instillation of an M-anticholinergic solution into both eyes, which will lead to anisocoria - a difference in pupil sizes. This is due to the fact that on the healthy side the pupil will dilate, but on the sick side it will not.
- Instillation of drops with an alpha-adrenergic agonist (for example, aproclonidine, cocaine hydrochloride) into the eyes also leads to pupil dilation in the healthy eye (mydriasis), in the absence of such a process on the side of the pathological process.
- Test with oxamphetamine - will reveal damage to the third neuron of the sympathetic pathway.
- Determination of the delay time of pupil dilation - determined using the direction of the light beam using, for example, an ophthalmoscope. Anisocoria is observed in Horner's syndrome.
- Magnetic resonance imaging, computed tomography, x-ray examination are used to identify pathological formations that contribute to the development of Horner's syndrome.
Drooping eyelid after botulinum toxin injection
According to statistics, after injections of botulinum toxin (Botox and other drugs containing it) into the eye area, drooping of the eyelid occurs in 20% of complicated cases, but this is almost always associated with errors during the procedure or is associated with the individual characteristics of the person.
Drooping of the eyelid after Botox injection is unpleasant, but, fortunately, it cannot be considered a serious pathology, since without additional therapy, signs of drooping completely disappear within 3-4 weeks after the injection of the drug.
Causes
There are many causes of Horner's syndrome, ranging from damage to the nervous system to congenital defects and pathologies.
Let's look at them in more detail:
- Physical impact directly on the thoracic or cervical circuits of the sympathetic system. This can be either compression or direct damage. Often symptoms occur on the side where the impact was made.
- With damage to brain tissue due to lateral medullary syndrome.
- The cause of the syndrome may be cluster headache. These are very severe headaches that are felt on the walls of the skull. The pain is so severe that there are frequent cases of suicide in order to get rid of such pain.
- Traumatic cause associated with severe bruising directly to the base of the neck. Surgical trauma is also possible.
- Due to various tumors. In particular, this is a Pancoast tumor.
- Manifestation of an aneurysm. Very often, Horner's syndrome occurs after an aortic aneurysm.
- Inflammatory processes in the middle ear area.
- The cause may also be direct dissection of the aneurysm.
- Tumor of the thyroid gland.
- The occurrence of this syndrome may be associated with an autoimmune disease, such as multiple sclerosis.
- Tension of the stellate nerve due to the presence of an additional cervical rib.
- The cause may also be a blockage of nerve centers.
- In case of a cut in the sympathetic nerve of the neck.
- The cause may be an inherited disease that can cause tumors throughout the body. This is the so-called neurofibromatosis type 1.
Rapid destruction of the meninges or serous meningitis in children - treatment and prevention of the disease.
A particularly dangerous cerebrospinal fluid cyst of the brain, the treatment of which can only be done surgically, has its own characteristics of diagnosis and symptoms.
Treatment of drooping eyelid
If the cause of drooping eyelid is a neurological disease, such as myasthenia gravis or neuropathy, then the underlying disease is treated first. Since ptosis is a symptom, it also goes away when the underlying disease is cured.
However, in some cases, complete recovery is impossible, and then surgical treatment is carried out for cosmetic purposes or, if ptosis leads to significant disruption of life due to deterioration of vision, then for therapeutic purposes.
Children undergo this operation no earlier than 3 years of age, but it should be done as soon as possible to prevent decreased vision and the development of strabismus.
In order to eliminate a cosmetic defect (when vision is not impaired), the operation is recommended to be performed after puberty, when the bony facial skeleton is finally formed.
If the prolapse is caused by injury, the operation can be performed directly during the initial treatment of the wound surface by the surgeon, or after healing, that is, after 6-12 months.
One way or another, the doctor makes a decision on the timing of the operation depending on the specific case.
Symptoms
To determine the presence of such a syndrome, a visual examination is sufficient. In most cases, the lesion occurs unilaterally. The severity of the manifestations often leads to the development of complexes about the patient’s appearance.
Characteristic symptoms:
- ptosis of the upper or lower eyelid;
- impaired visual acuity;
- narrowing and asymmetry of the pupils;
- impaired photoreaction;
- the pupils slowly adapt to changes in lighting;
- lack of eye reaction to the use of medications;
- hardening of the eyeball;
- decreased or complete absence of sweating on one side of the face;
- red color of the affected eye;
- difference in eye color in pediatric patients;
- chaotic placement of color pigments;
- dry eye syndrome;
- the affected part of the face sags;
- doubling of objects before the eyes.
The disease is accompanied by characteristic signs that will help diagnose the presence of this pathology. Even the presence of 1-2 symptoms may indicate the presence of this syndrome. Therefore, if there are suspicions, you should consult a doctor. Timely diagnosis will help avoid the development of complications and severe forms.
Doctors share another form - this is an incomplete syndrome. In this case, characteristic symptoms are completely absent. This leads to the danger of this pathology. Only an experienced ophthalmologist can diagnose this type of syndrome. It is difficult to cure any form of this syndrome. Initially, the doctor must determine the cause of its development, and then prescribe treatment. Efficiency is observed when using minimal electrical currents.
Preventing the development of drooping eyelids
An important point in the prevention of eyelid drooping is the timely treatment of any diseases that can provoke this pathology. For example, neuritis of the facial nerves must be immediately treated by a neurologist, and the possibility of drooping eyelids after Botox injections should be discussed with the specialist performing the manipulation.
If you notice weakness of the eyelids associated with age-related changes, then cosmetics and folk remedies can help you. Prevention methods include the use of tightening masks, oils and massage treatments.
Massage of the skin of the eyelids should be carried out with drooping eyelids. Before the procedure, the eyelids can be wiped with lotion to remove sebaceous scales and open the excretory ducts of the sebaceous glands. Massage using a cotton swab or disk soaked in an antiseptic solution or special ointment. Use stroking with light pressure, making circular and linear movements, moving from the inner corner of the eye to the outer corner. You can lightly tap your eyelids with your fingertips.
There are special gymnastics for weakness of the eye muscles.
Starting position – standing, sitting or lying down.
- We look up, without raising our heads, then sharply down. We repeat the movements 6-8 times.
- We look up and to the right, then diagonally down and to the left. We repeat the movements 6-8 times.
- We look up and to the left, then down and to the right. We repeat the movements 6-8 times.
- We look as far as possible to the left, then as far as possible to the right. We repeat the movements 6-8 times.
- We stretch our arm forward and keep it straight. We look at the tip of the index finger and gradually bring it closer, without stopping looking until the picture begins to “double.” We repeat the movements 6-8 times.
- Place your index finger on the bridge of your nose. We look at the finger alternately with the right and left eyes. Repeat 10-12 times.
- We move our eyes in a circle to the right and left. We repeat the movements 6-8 times.
- We blink quickly for 15 seconds. Repeat blinking up to 4 times.
- We close our eyes tightly for 5 seconds, then sharply open our eyes for 5 seconds. Repeat 10 times.
- Close your eyes and massage your eyelids with your finger in a circle for 1 minute.
- We shift our gaze from the nearest point to the far one and vice versa.
Movements of the eyeball during exercises should be as wide as possible, but not to the point of pain. The motor tempo can be made more difficult over time. The duration of such prophylaxis is at least 3 months.
It is worth noting that in case of myasthenia gravis and myopathy, such exercises are contraindicated, as they contribute to the worsening of drooping eyelids due to “exhaustion” of the muscle. Therefore, before engaging in any treatment, you must consult a specialist.
Preventive measures
The specificity of Horner's syndrome is that it does not have special courses of treatment and prevention.
After all, it is often a symptom of a more complex and systemic disease, which already has direct methods of treatment and prevention.
The presence of the syndrome is very often determined only for the sake of exclusion or detection of a possible more serious disease that can threaten the patient’s life.
Bernard Horner syndrome is a specific disease associated with complications in the functioning of the sympathetic nerves , or their damage.
It has a number of specific symptoms, as well as methods of treatment and diagnosis of the disease. As a separate disease, it does not threaten the patient’s life, but only causes cosmetic and physical discomfort.
If the syndrome is caused by another, more serious disease, it can already pose a threat to a person’s life.
Treatment of this syndrome is carried out by stimulating the affected tissues or eliminating the cause of its occurrence. When treating this disease, it is important to consult a specialist in time to prevent truly dangerous complications.
Our doctors
Pankov Alexander Rostislavovich
Neurologist
40 years of experience
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Novikova Larisa Vaganovna
Neuropathologist, Candidate of Medical Sciences, doctor of the highest category
Experience 39 years
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Forecast of drooping eyelid
As a rule, ptosis requires either treatment of the disease that caused it, or purely cosmetic correction, or both.
When treated for cosmetic purposes, the prognosis is favorable. If surgical treatment was performed on a child, then he is monitored periodically throughout his growth period. For myasthenia gravis, the selection of adequate therapy or complete cure for myasthenia gravis can eliminate ptosis. With the exception of cases where, due to prolonged drooping of the eyelid, overstretching of the muscle tendon has occurred, then the defect becomes purely cosmetic and is eliminated surgically.
In all other cases of neurological pathology (syncinesia, neuropathy, facial nerve paralysis, myopathy), the prognosis depends entirely on the initial disease and the prognosis for its treatment.
Make an appointment through the application or by calling +7 +7 We work every day:
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- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
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Treatment
Claude Bernard Horner syndrome is very difficult to treat. Therefore, timely diagnosis plays an important role. Effective results are shown by the use of neurostimulation. Electrical impulses pass through the affected muscles. Thanks to this, their functionality is fully or partially restored. In most cases, such therapy has a positive result.
If the pathology develops against the background of hormonal disorders, then doctors use medicinal treatment with hormones. If these methods show insufficient effectiveness, then doctors recommend surgical intervention. Plastic surgery can eliminate such a cosmetic defect.
The possibility of kinesitherapy should not be excluded. In some cases it turns out to be very effective. Its essence lies in conducting a special massage. It provides simulations of the functionality of the affected areas. The use of traditional medicine in this case is inappropriate. The patient is prohibited from self-medicating. Drug therapy is mainly prescribed for systematic diseases.
